{"id":32179,"date":"2023-05-07T13:27:00","date_gmt":"2023-05-07T06:27:00","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32179"},"modified":"2023-05-17T01:41:26","modified_gmt":"2023-05-16T18:41:26","slug":"danh-gia-do-nang-thuyen-tac-phoi-esc-2019","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/danh-gia-do-nang-thuyen-tac-phoi-esc-2019\/","title":{"rendered":"\u0110\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i &#8211; ESC 2019\u00a0"},"content":{"rendered":"<p><b>Thuy\u00ean t\u1eafc ph\u1ed5i l\u00e0 b\u1ec7nh c\u1ea7n ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb nhanh ch\u00f3ng nh\u1eb1m h\u1ea1n ch\u1ebf nguy c\u01a1 t\u1eed vong. \u0110\u1ec3 ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n, b\u00ean c\u1ea1nh nh\u1eadn \u0111\u1ecbnh l\u00e2m s\u00e0ng, vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i v\u00e0 nguy c\u01a1 t\u1eed vong c\u0169ng \u0111\u00f3ng vai tr\u00f2 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng.<\/b><\/p>\n<figure id=\"attachment_32189\" aria-describedby=\"caption-attachment-32189\" style=\"width: 800px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-32189\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/F0271974-Pulmonary_embolism_illustration.jpg\" alt=\"pulmonary-embolism\" width=\"800\" height=\"500\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/F0271974-Pulmonary_embolism_illustration.jpg 800w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/F0271974-Pulmonary_embolism_illustration-300x188.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/F0271974-Pulmonary_embolism_illustration-768x480.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption id=\"caption-attachment-32189\" class=\"wp-caption-text\">Thuy\u00ean t\u1eafc ph\u1ed5i do huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u di chuy\u1ec3n \u0111\u1ebfn m\u1ea1ch ph\u1ed5i.<\/figcaption><\/figure>\n<h2><strong>1. \u0110\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i v\u00e0 nguy c\u01a1 t\u1eed vong s\u1edbm<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">\u00a0Ph\u00e2n t\u1ea7ng nguy c\u01a1 c\u1ee7a b\u1ec7nh nh\u00e2n PE c\u1ea5p t\u00ednh l\u00e0 b\u1eaft bu\u1ed9c \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p. ph\u00e2n t\u1ea7ng r\u1ee7i ro ban \u0111\u1ea7u d\u1ef1a tr\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u1ec1 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng, nh\u1eefng d\u1ea5u hi\u1ec7u cho th\u1ea5y nguy c\u01a1 cao t\u1eed vong s\u1edbm. C\u00f2n nh\u00f3m l\u1edbn b\u1ec7nh nh\u00e2n PE c\u00f2n l\u1ea1i, l\u00e0 nh\u00f3m kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng, th\u00ec ph\u00e2n t\u1ea7ng nguy c\u01a1 ti\u1ebfp theo (n\u00e2ng cao) \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111\u00e1nh gi\u00e1 hai b\u1ed9 ti\u00eau chu\u1ea9n ti\u00ean l\u01b0\u1ee3ng:<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<strong>(i)<\/strong> l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh v\u00e0 ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m v\u1ec1 \u0111\u1ed9 n\u1eb7ng c\u1ee7a PE, ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV;\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>\u00a0(ii)<\/strong> S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u1ec7nh \u0111\u1ed3ng m\u1eafc v\u00e0 b\u1ea5t k\u1ef3 t\u00ecnh tr\u1ea1ng l\u00e0m n\u1eb7ng th\u00eam n\u00e0o kh\u00e1c c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng x\u1ea5u \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng s\u1edbm.\u00a0<\/span><\/p>\n<h3><strong>1.1 Th\u00f4ng s\u1ed1 l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i\u00a0<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">Suy RV c\u1ea5p t\u00ednh, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng ti\u1ebfn tri\u1ec3n nhanh ch\u00f3ng v\u1edbi sung huy\u1ebft h\u1ec7 th\u1ed1ng do gi\u1ea3m l\u00e0m \u0111\u1ea7y RV v\u00e0\/ho\u1eb7c gi\u1ea3m cung l\u01b0\u1ee3ng RV, l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh quan tr\u1ecdng \u0111\u1ebfn k\u1ebft c\u1ee5c trong PE c\u1ea5p t\u00ednh. T\u1ea7n s\u1ed1 tim nhanh, HA t\u00e2m thu th\u1ea5p, h\u00f4 h\u1ea5p kh\u00f4ng hi\u1ec7u qu\u1ea3 (th\u1edf nhanh v\u00e0\/ho\u1eb7c SaO2 th\u1ea5p) v\u00e0 ng\u1ea5t, ri\u00eang l\u1ebb ho\u1eb7c k\u1ebft h\u1ee3p, \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng ng\u1eafn h\u1ea1n kh\u00f4ng thu\u1eadn l\u1ee3i \u1edf PE c\u1ea5p t\u00ednh.<\/span><\/p>\n<h3><strong>1.2 Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u1ec1 k\u00edch th\u01b0\u1edbc v\u00e0 ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t ph\u1ea3i<\/strong><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">\u00a0<a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/sieu-am-tim-co-cho-biet-dieu-gi\/\"><em>Si\u00eau \u00e2m tim\u00a0<\/em><\/a><\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">C\u00e1c th\u00f4ng s\u1ed1 si\u00eau \u00e2m tim \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u1ea7ng nguy c\u01a1 s\u1edbm b\u1ec7nh nh\u00e2n m\u1eafc PE \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y b\u1eb1ng h\u00ecnh \u1ea3nh trong H\u00ecnh 3 v\u00e0 c\u00e1c gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng c\u1ee7a ch\u00fang \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong m\u1ee5c d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 3. Trong nh\u1eefng th\u00f4ng s\u1ed1 n\u00e0y, t\u1ec9 l\u1ec7 \u0111\u01b0\u1eddng k\u00ednh RV\/LV \u22651.0 v\u00e0 TAPSE &lt;16mm l\u00e0 nh\u1eefng ch\u1ec9 s\u1ed1 c\u00f3 m\u1ed1i li\u00ean h\u1ec7 v\u1edbi ti\u00ean l\u01b0\u1ee3ng kh\u00f4ng thu\u1eadn l\u1ee3i th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o nh\u1ea5t.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Nh\u00ecn chung, b\u1eb1ng ch\u1ee9ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV tr\u00ean si\u00eau \u00e2m tim \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf \u226525% b\u1ec7nh nh\u00e2n PE c\u1ea5p kh\u00f4ng ch\u1ecdn l\u1ecdc. C\u00e1c t\u1ed5ng quan h\u1ec7 th\u1ed1ng v\u00e0 ph\u00e2n t\u00edch g\u1ed9p \u0111\u00e3 g\u1ee3i \u00fd r\u1eb1ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV tr\u00ean si\u00eau \u00e2m tim c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 t\u1eed vong ng\u1eafn h\u1ea1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh khi nh\u1eadp vi\u1ec7n, nh\u01b0ng nh\u00ecn chung gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng cho t\u1eed vong li\u00ean quan \u0111\u1ebfn PE l\u00e0 th\u1ea5p (&lt;10%) trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p. \u0110i\u1ec3m y\u1ebfu n\u00e0y li\u00ean quan m\u1ed9t ph\u1ea7n \u0111\u1ebfn th\u1ef1c t\u1ebf l\u00e0 c\u00e1c th\u00f4ng s\u1ed1 si\u00eau \u00e2m tim \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 kh\u00f3 chu\u1ea9n h\u00f3a. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Tuy nhi\u00ean, \u0111\u00e1nh gi\u00e1 si\u00eau \u00e2m tim v\u1ec1 h\u00ecnh th\u00e1i h\u1ecdc v\u00e0 ch\u1ee9c n\u0103ng RV \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn r\u1ed9ng r\u00e3i nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 c\u00f3 gi\u00e1 tr\u1ecb trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng nh\u1eefng b\u1ec7nh nh\u00e2n PE c\u1ea5p t\u00ednh m\u00e0 huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ngo\u00e0i r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV, si\u00eau \u00e2m tim c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh shunt ph\u1ea3i-tr\u00e1i th\u00f4ng qua l\u1ed7 b\u1ea7u d\u1ee5c v\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a huy\u1ebft kh\u1ed1i tim ph\u1ea3i, c\u1ea3 hai \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n PE c\u1ea5p. L\u1ed7 b\u1ea7u d\u1ee5c c\u0169ng l\u00e0m t\u0103ng nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u do thuy\u00ean t\u1eafc n\u00e3o ngh\u1ecbch th\u01b0\u1eddng \u1edf b\u1ec7nh nh\u00e2n PE c\u1ea5p v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV.<\/span><\/p>\n<ul>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chup-cat-lop-vi-tinh-phoi-nhung-dieu-can-biet\/\"><em><span style=\"font-weight: 400;\">Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u ph\u1ed5i (CTPA)<\/span><\/em><\/a><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u00a0C\u00e1c th\u00f4ng s\u1ed1 CTPA \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u1ea7ng nguy c\u01a1 s\u1edbm c\u1ee7a b\u1ec7nh nh\u00e2n m\u1eafc PE \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong m\u1ee5c d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 3. M\u1eb7t c\u1eaft 4 bu\u1ed3ng tim khi ch\u1ee5p CT m\u1ea1ch m\u00e1u c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n ph\u00ec \u0111\u1ea1i RV (\u0111\u01b0\u1eddng k\u00ednh cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng RV v\u00e0 t\u1ef7 l\u1ec7 RV\/LV \u0111\u01b0\u1ee3c \u0111o theo m\u1eb7t c\u1eaft ngang ho\u1eb7c b\u1ed1n bu\u1ed3ng) nh\u01b0 l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"> Gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng c\u1ee7a m\u1ed9t RV ph\u00ec \u0111\u1ea1i \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 b\u1edfi c\u00e1c k\u1ebft qu\u1ea3 c\u1ee7a m\u1ed9t nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u \u0111o\u00e0n h\u1ec7 \u0111a trung t\u00e2m v\u1edbi 457 b\u1ec7nh nh\u00e2n. Trong nghi\u00ean c\u1ee9u \u0111\u00f3, RV ph\u00ec \u0111\u1ea1i (\u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u1ef7 l\u1ec7 RV\/LV \u22650.9) l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 ti\u00ean \u0111o\u00e1n \u0111\u1ed9c l\u1eadp v\u1ec1 k\u1ebft c\u1ee5c b\u1ea5t l\u1ee3i trong b\u1ec7nh vi\u1ec7n, c\u1ea3 trong d\u00e2n s\u1ed1 PE chung [t\u1ef7 s\u1ed1 hazard (HR) 3.5, 95% CI 1.6-7.7] v\u00e0 c\u1ea3 v\u1edbi b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh v\u1ec1 huy\u1ebft \u0111\u1ed9ng (HR 3.8, 95% CI 1.3-10.9) . M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p c\u1ee7a 49 nghi\u00ean c\u1ee9u v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u1edbi &gt;13.000 b\u1ec7nh nh\u00e2n PE x\u00e1c \u0111\u1ecbnh r\u1eb1ng t\u1ef7 l\u1ec7 RV\/LV t\u0103ng \u22651.0 tr\u00ean CT c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng 2.5 l\u1ea7n nguy c\u01a1 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n [odds ratio (OR) 2.5, 95% CI 1.8-3.5] v\u00e0 c\u00f3 t\u0103ng 5 l\u1ea7n nguy c\u01a1 t\u1eed vong li\u00ean quan \u0111\u1ebfn PE (OR 5.0, 95% CI 2.7-9.2).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0RV gi\u00e3n nh\u1eb9 (RV\/LV h\u01a1i cao h\u01a1n 0.9) tr\u00ean CT l\u00e0 th\u01b0\u1eddng g\u1eb7p (&gt;50% b\u1ec7nh nh\u00e2n PE huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh), nh\u01b0ng c\u00f3 l\u1ebd n\u00f3 c\u00f3 \u00fd ngh\u0129a ti\u00ean l\u01b0\u1ee3ng kh\u00f4ng \u0111\u00e1ng k\u1ec3. Tuy nhi\u00ean, t\u0103ng t\u1ef7 l\u1ec7 \u0111\u01b0\u1eddng k\u00ednh RV\/LV c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u ti\u00ean l\u01b0\u1ee3ng, Khuy\u1ebfn c\u00e1o 2019 t\u1eeb ESC Thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p 31 L\u00ea Vi\u1ec7t Tr\u00e2n d\u1ecbch ngay c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 nguy c\u01a1 <strong>\u2019th\u1ea5p\u2019<\/strong> d\u1ef1a tr\u00ean ti\u00eau ch\u00ed l\u00e2m s\u00e0ng. Nh\u01b0 v\u1eady, t\u1ef7 l\u1ec7 RV\/LV \u22651.0 (thay v\u00ec 0.9) tr\u00ean CT m\u1ea1ch m\u00e1u c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p h\u01a1n \u0111\u1ec3 n\u00f3i l\u00ean ti\u00ean l\u01b0\u1ee3ng x\u1ea5u.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Ngo\u00e0i k\u00edch th\u01b0\u1edbc RV v\u00e0 t\u1ef7 l\u1ec7 RV\/LV, CT c\u00f3 th\u1ec3 cung c\u1ea5p th\u00eam th\u00f4ng tin ti\u00ean l\u01b0\u1ee3ng d\u1ef1a tr\u00ean ph\u00e2n t\u00edch th\u1ec3 t\u00edch c\u1ee7a c\u00e1c bu\u1ed3ng tim v\u00e0 \u0111\u00e1nh gi\u00e1 d\u1ed9i ng\u01b0\u1ee3c ch\u1ea5t c\u1ea3n quang v\u1ec1 t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi (IVC).\u00a0<\/span><\/p>\n<h3><a href=\"https:\/\/vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/xet-nghiem-dau-sinh-hoc-de-tim-ung-thu-phoi\/\"><strong>1.3 X\u00e9t nghi\u1ec7m d\u1ea5u \u1ea5n sinh h\u1ecdc<\/strong><\/a><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\"><em>\u00a0<a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/xet-nghiem-troponin-t-trong-danh-gia-suy-tim-nhoi-mau-co-tim\/\">D\u1ea5u \u1ea5n t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim<\/a><\/em>\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">N\u1ed3ng \u0111\u1ed9 <strong>troponin<\/strong> trong huy\u1ebft t\u01b0\u01a1ng t\u0103ng khi nh\u1eadp vi\u1ec7n c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng x\u1ea5u h\u01a1n trong PE giai \u0111o\u1ea1n c\u1ea5p. Troponin tim I ho\u1eb7c T t\u0103ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 n\u1ed3ng \u0111\u1ed9 tr\u00ean gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng, v\u00e0 ng\u01b0\u1ee1ng ph\u1ee5 thu\u1ed9c v\u00e0o x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng; t\u1ed5ng quan v\u1ec1 c\u00e1c gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a ra b\u1edfi m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p. Trong s\u1ed1 c\u00e1c b\u1ec7nh nh\u00e2n PE c\u1ea5p t\u00ednh, kho\u1ea3ng t\u1eeb 30 (s\u1eed d\u1ee5ng c\u00e1c x\u00e9t nghi\u1ec7m th\u01b0\u1eddng) \u0111\u1ebfn 60% (s\u1eed d\u1ee5ng c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u1ed9 nh\u1ea1y cao) c\u00f3 n\u1ed3ng \u0111\u1ed9 troponin I ho\u1eb7c T tim t\u0103ng cao. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y n\u1ed3ng \u0111\u1ed9 troponin t\u0103ng cao c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 t\u1eed vong, \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng ch\u1ecdn l\u1ecdc (OR 5.2, 95% CI 3.3-8.4) v\u00e0 c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh khi nghi\u00ean c\u1ee9u (OR 5.9, 95% CI 2.7-13.0).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0N\u1ebfu x\u00e9t ri\u00eang l\u1ebb, t\u0103ng n\u1ed3ng \u0111\u1ed9 troponin tim trong tu\u1ea7n ho\u00e0n c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u00e0 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng t\u01b0\u01a1ng \u0111\u1ed1i th\u1ea5p cho t\u1eed vong s\u1edbm \u1edf b\u1ec7nh nh\u00e2n PE c\u1ea5p c\u00f3 huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng. Tuy nhi\u00ean, khi xem x\u00e9t k\u1ebft h\u1ee3p v\u1edbi l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, ch\u00fang c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n vi\u1ec7c x\u00e1c \u0111\u1ecbnh nguy c\u01a1 li\u00ean quan \u0111\u1ebfn PE t\u0103ng l\u00ean v\u00e0 s\u1ef1 ph\u00e2n t\u1ea7ng ti\u00ean l\u01b0\u1ee3ng xa h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y (d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 4). \u1ede \u0111\u1ea7u kia c\u1ee7a ph\u1ed5 \u0111\u1ed9 n\u1eb7ng, x\u00e9t nghi\u1ec7m troponin \u0111\u1ed9 nh\u1ea1y cao c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m cao trong b\u1ed1i c\u1ea3nh PE c\u1ea5p. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">V\u00ed d\u1ee5: trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 ti\u1ebfn c\u1ee9u \u0111a trung t\u00e2m v\u1edbi 526 b\u1ec7nh nh\u00e2n huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng, n\u1ed3ng \u0111\u1ed9 troponin T \u0111\u1ed9 nh\u1ea1y cao &lt;14 pg\/mL c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n \u00e2m l\u00e0 98% \u0111\u1ec3 lo\u1ea1i tr\u1eeb m\u1ed9t k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng b\u1ea5t l\u1ee3i trong b\u1ec7nh vi\u1ec7n. Ng\u01b0\u1ee1ng c\u1eaft troponin T \u0111\u1ed9 nh\u1ea1y cao \u0111i\u1ec1u ch\u1ec9nh theo tu\u1ed5i (\u226514 pg\/mL cho b\u1ec7nh nh\u00e2n &lt;75 tu\u1ed5i v\u00e0 \u226545 pg\/mL \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi \u226575 n\u0103m) c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n h\u01a1n n\u1eefa gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m c\u1ee7a d\u1ea5u \u1ea5n sinh h\u1ecdc n\u00e0y.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Protein g\u1eafn k\u1ebft axit b\u00e9o lo\u1ea1i tim (H-FABP), m\u1ed9t d\u1ea5u ch\u1ec9 s\u1edbm v\u00e0 nh\u1ea1y \u0111\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim, cung c\u1ea5p th\u00f4ng tin ti\u00ean l\u01b0\u1ee3ng trong PE c\u1ea5p t\u00ednh, c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng ch\u1ecdn l\u1ecdc v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng. Trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p \u0111i\u1ec1u tra 1680 b\u1ec7nh nh\u00e2n m\u1eafc PE, n\u1ed3ng \u0111\u1ed9 H-FABP \u22656 ng\/mL c\u00f3 li\u00ean quan \u0111\u1ebfn k\u1ebft c\u1ee5c b\u1ea5t l\u1ee3i ng\u1eafn h\u1ea1n (OR 17.7, 95% CI 6.0-51.9) v\u00e0 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n (OR 32.9, 95% CI 8.8-123.2).<\/span><\/p>\n<ul>\n<li><em><span style=\"font-weight: 400;\">\u00a0<a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/cac-trieu-chung-suy-giam-chuc-nang-tam-thu-that\/\">Ch\u1ec9 d\u1ea5u c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i\u00a0<\/a><\/span><\/em><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Qu\u00e1 t\u1ea3i \u00e1p l\u1ef1c RV do PE c\u1ea5p c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng \u0111\u1ed9 c\u0103ng c\u01a1 tim, d\u1eabn \u0111\u1ebfn gi\u1ea3i ph\u00f3ng <a href=\"https:\/\/vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/vai-tro-cua-dinh-luong-nt-pro-bnp-trong-chan-doan-benh-suy-tim\/?link_type=related_posts\"><strong>natriuretic peptide lo\u1ea1i B (BNP) v\u00e0 N-terminal (NT)-proBNP<\/strong><\/a>. Do \u0111\u00f3, n\u1ed3ng \u0111\u1ed9 natriuretic peptide huy\u1ebft t\u01b0\u01a1ng ph\u1ea3n \u00e1nh \u0111\u1ed9 n\u1eb7ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV v\u00e0 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng trong PE c\u1ea5p. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y 51% trong s\u1ed1 1132 b\u1ec7nh nh\u00e2n PE c\u1ea5p kh\u00f4ng ch\u1ecdn l\u1ecdc c\u00f3 BNP ho\u1eb7c n\u1ed3ng \u0111\u1ed9 NT-proBNP t\u0103ng khi nh\u1eadp vi\u1ec7n; nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 10% nguy c\u01a1 t\u1eed vong s\u1edbm (95% CI 8.0-13%) v\u00e0 23% (95% CI 20- 26%) nguy c\u01a1 k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng b\u1ea5t l\u1ee3i.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0T\u01b0\u01a1ng t\u1ef1 troponin tim (xem \u1edf tr\u00ean), n\u1ed3ng \u0111\u1ed9 BNP ho\u1eb7c NT-proBNP t\u0103ng cao c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u00e0 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng th\u1ea5p (\u0111\u1ed1i v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong s\u1edbm) \u1edf b\u1ec7nh nh\u00e2n PE huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng, nh\u01b0ng n\u1ed3ng \u0111\u1ed9 BNP ho\u1eb7c NT-proBNP th\u1ea5p c\u00f3 kh\u1ea3 n\u0103ng lo\u1ea1i tr\u1eeb m\u1ed9t k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng b\u1ea5t l\u1ee3i s\u1edbm, do \u0111\u1ed9 nh\u1ea1y v\u00e0 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m cao. V\u1ec1 v\u1ea5n \u0111\u1ec1 n\u00e0y, ng\u01b0\u1ee1ng c\u1eaft NT-proBNP &lt;500 pg\/mL \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ecdn b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb t\u1ea1i nh\u00e0 trong m\u1ed9t nghi\u00ean c\u1ee9u v\u1ec1 qu\u1ea3n l\u00fd \u0111a trung t\u00e2m. N\u1ebfu nh\u1ea5n m\u1ea1nh v\u00e0o vi\u1ec7c t\u0103ng \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u1ec1 ti\u00ean l\u01b0\u1ee3ng cho k\u1ebft c\u1ee5c b\u1ea5t l\u1ee3i s\u1edbm, gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng cao h\u01a1n \u2265600 pg\/mL c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p h\u01a1n.\u00a0<\/span><\/p>\n<ul>\n<li><em><span style=\"font-weight: 400;\">C\u00e1c x\u00e9t nghi\u1ec7m d\u1ea5u \u1ea5n sinh h\u1ecdc kh\u00e1c<\/span><\/em><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/y-nghia-xet-nghiem-lactate-mau\/\"><strong>\u00a0Lactate<\/strong><\/a> l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u c\u1ee7a s\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa cung c\u1ea5p v\u00e0 nhu c\u1ea7u ti\u00eau th\u1ee5 oxy m\u00f4, v\u00e0 l\u00e0 h\u1ec7 qu\u1ea3 c\u1ee7a PE n\u1eb7ng c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng r\u00f5 r\u00e0ng ho\u1eb7c d\u1ecda x\u1ea3y ra. N\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch cao \u22652 mmol\/L d\u1ef1 \u0111o\u00e1n c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn PE, c\u1ea3 \u1edf b\u1ec7nh nh\u00e2n PE kh\u00f4ng ch\u1ecdn l\u1ecdc v\u00e0 b\u1ec7nh nh\u00e2n huy\u1ebft \u00e1p ban \u0111\u1ea7u b\u00ecnh th\u01b0\u1eddng.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">T\u0103ng n\u1ed3ng \u0111\u1ed9 creatinin huy\u1ebft thanh v\u00e0 gi\u1ea3m \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (t\u00ednh to\u00e1n) c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n trong 30 ng\u00e0y trong PE c\u1ea5p. T\u0103ng neutrophil gelatinase-associated lipocalin (NGAL) v\u00e0 cystatin C, c\u1ea3 hai ch\u1ec9 s\u1ed1 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p t\u00ednh, c\u0169ng c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p g\u1ea7n \u0111\u00e2y nghi\u00ean c\u1ee9u 18 616 b\u1ec7nh nh\u00e2n m\u1eafc PE c\u1ea5p th\u1ea5y r\u1eb1ng h\u1ea1 natri m\u00e1u d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c t\u1eed vong trong b\u1ec7nh vi\u1ec7n (OR 5.6, 95% CI 3.4-9.1).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Vasopressin \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng khi c\u0103ng th\u1eb3ng n\u1ed9i sinh, t\u1ee5t huy\u1ebft \u00e1p v\u00e0 cung l\u01b0\u1ee3ng tim th\u1ea5p. Ch\u1ec9 d\u1ea5u \u0111\u1ea1i di\u1ec7n c\u1ee7a n\u00f3, copeptin, \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 h\u1eefu \u00edch trong ph\u00e2n t\u1ea7ng nguy c\u01a1 b\u1ec7nh nh\u00e2n PE c\u1ea5p t\u00ednh. Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111\u01a1n trung t\u00e2m \u0111i\u1ec1u tra 268 b\u1ec7nh nh\u00e2n PE c\u00f3 huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng, n\u1ed3ng \u0111\u1ed9 copeptin \u226524 pmol\/L li\u00ean quan v\u1edbi t\u0103ng 5.4 l\u1ea7n nguy c\u01a1 k\u1ebft c\u1ee5c b\u1ea5t l\u1ee3i (95% CI 1.7-17.6). Nh\u1eefng k\u1ebft qu\u1ea3 n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn \u1edf 843 b\u1ec7nh nh\u00e2n PE c\u00f3 huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng ti\u1ebfn c\u1ee9u trong ba nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 \u1edf ch\u00e2u \u00c2u.\u00a0<\/span><\/p>\n<h3><strong>1.4. C\u00e1c th\u00f4ng s\u1ed1 v\u00e0 \u0111i\u1ec3m s\u1ed1 k\u1ebft h\u1ee3p \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n m\u00e0 kh\u00f4ng r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng, khi s\u1eed d\u1ee5ng \u0111\u01a1n l\u1ebb, c\u00e1c th\u00f4ng s\u1ed1 kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u00e0 ph\u00e2n \u0111\u1ed9 n\u1eb7ng PE v\u00e0 nguy c\u01a1 s\u1edbm li\u00ean quan \u0111\u1ebfn PE. V\u00ec th\u1ebf, nhi\u1ec1u s\u1ef1 k\u1ebft h\u1ee3p c\u00e1c th\u00f4ng s\u1ed1 l\u00e2m s\u00e0ng, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf tr\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e2y d\u1ef1ng thang \u0111i\u1ec3m ti\u00ean l\u01b0\u1ee3ng, cho ph\u00e9p <strong>\u0111\u00e1nh gi\u00e1 (b\u00e1n) \u0111\u1ecbnh l\u01b0\u1ee3ng<\/strong> nguy c\u01a1 t\u1eed vong s\u1edbm li\u00ean quan \u0111\u1ebfn thuy\u00ean t\u1eafc ph\u1ed5i.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Trong c\u00e1c thang \u0111i\u1ec3m n\u00e0y, th\u00ec <strong>thang \u0111i\u1ec3m Bova<\/strong> v\u00e0 <strong>thang \u0111i\u1ec3m FAST <\/strong>(bao g\u1ed3m x\u00e9t nghi\u1ec7m H-FABP (ho\u1eb7c troponin T c\u00f3 \u0111\u1ed9 nh\u1ea1y cao), ng\u1ea5t, t\u1ea7n s\u1ed1 tim nhanh) \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c th\u1ef1c trong c\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 (xem d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 4). Tuy nhi\u00ean, \u00fd ngh\u0129a c\u1ee7a ch\u00fang \u0111\u1ed1i v\u1edbi qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng. Cho \u0111\u1ebfn nay, ch\u1ec9 c\u00f3 s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV tr\u00ean si\u00eau \u00e2m tim (ho\u1eb7c CTPA) v\u1edbi x\u00e9t nghi\u1ec7m troponin tim d\u01b0\u01a1ng t\u00ednh l\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m tr\u1ef1c ti\u1ebfp nh\u01b0 m\u1ed9t h\u01b0\u1edbng d\u1eabn quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb s\u1edbm (ch\u1ed1ng \u0111\u00f4ng m\u00e1u c\u1ed9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u so v\u1edbi ch\u1ed1ng \u0111\u00f4ng \u0111\u01a1n thu\u1ea7n) trong m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng (RCT) l\u1edbn tr\u00ean b\u1ec7nh nh\u00e2n PE kh\u00f4ng r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">\u00a01<strong>.5. T\u00edch h\u1ee3p c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m n\u1eb7ng v\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc trong \u0111\u00e1nh gi\u00e1 nguy c\u01a1 thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh.<\/strong><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Ngo\u00e0i l\u00e2m s\u00e0ng, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m, l\u00e0 c\u00f3 li\u00ean quan tr\u1ef1c ti\u1ebfp \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a PE v\u00e0 t\u1eed vong s\u1edbm li\u00ean quan \u0111\u1ebfn PE th\u00ec c\u00e1c th\u00f4ng s\u1ed1 li\u00ean quan \u0111\u1ebfn t\u00ecnh tr\u1ea1ng l\u00e0m n\u1eb7ng v\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u1eed vong chung v\u00e0 k\u1ebft c\u1ee5c s\u1edbm c\u1ee7a b\u1ec7nh nh\u00e2n. Trong s\u1ed1 c\u00e1c \u0111i\u1ec3m l\u00e2m s\u00e0ng t\u00edch h\u1ee3p \u0111\u1ed9 n\u1eb7ng PE v\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc, ch\u1ec9 s\u1ed1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i (PESI) (B\u1ea3ng 7) l\u00e0 thang \u0111i\u1ec3m \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c th\u1ef1c r\u1ed9ng r\u00e3i nh\u1ea5t cho \u0111\u1ebfn nay. \u0110i\u1ec3m m\u1ea1nh ch\u00ednh c\u1ee7a PESI n\u1eb1m \u1edf vi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ed9t c\u00e1ch \u0111\u00e1ng tin c\u1eady nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p t\u1eed vong trong 30 ng\u00e0y (PESI lo\u1ea1i I v\u00e0 II). M\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean \u0111\u00e3 s\u1eed d\u1ee5ng \u0111i\u1ec3m PESI th\u1ea5p l\u00e0m ti\u00eau ch\u00ed ch\u00ednh cho ph\u00e9p \u0111i\u1ec1u tr\u1ecb PE c\u1ea5p t\u1ea1i nh\u00e0.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0V\u00ec s\u1ef1 ph\u1ee9c t\u1ea1p c\u1ee7a thang \u0111i\u1ec3m PESI g\u1ed1c, g\u1ed3m 11 bi\u1ebfn c\u00f3 s\u1ed1 \u0111i\u1ec3m kh\u00e1c nhau, n\u00ean m\u1ed9t phi\u00ean b\u1ea3n \u0111\u01a1n gi\u1ea3n h\u00f3a (sPESI; B\u1ea3ng 7) \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u00e0 \u0111\u01b0\u1ee3c ki\u1ec3m ch\u1ee9ng. Gi\u1ed1ng nh\u01b0 PESI b\u1ea3n g\u1ed1c, \u01b0u \u0111i\u1ec3m c\u1ee7a sPESI n\u1eb1m \u1edf vi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ed9t c\u00e1ch \u0111\u00e1ng tin c\u1eady nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p t\u1eed vong trong 30 ng\u00e0y. Kh\u1ea3 n\u0103ng ti\u00ean l\u01b0\u1ee3ng c\u1ee7a sPESI \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn trong c\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 quan s\u00e1t, m\u1eb7c d\u00f9 ch\u1ec9 s\u1ed1 n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn qu\u1ea3n l\u00fd \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n PE nguy c\u01a1 th\u1ea5p.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Ch\u1ea9n \u0111o\u00e1n DVT \u0111\u1ed3ng m\u1eafc \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng b\u1ea5t l\u1ee3i, li\u00ean quan \u0111\u1ed9c l\u1eadp v\u1edbi t\u1eed vong trong v\u00f2ng 3 th\u00e1ng \u0111\u1ea7u sau PE c\u1ea5p. Trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p nghi\u00ean c\u1ee9u tr\u00ean 8859 b\u1ec7nh nh\u00e2n PE, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a DVT \u0111\u1ed3ng th\u1eddi \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn l\u00e0 y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n trong 30 ng\u00e0y (OR 1.9, 95% CI 1.5-2.4), m\u1eb7c d\u00f9 n\u00f3 kh\u00f4ng d\u1ef1 \u0111o\u00e1n c\u00e1c k\u1ebft qu\u1ea3 b\u1ea5t l\u1ee3i li\u00ean quan \u0111\u1ebfn PE trong 90 ng\u00e0y. Do \u0111\u00f3, DVT \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem nh\u01b0 l\u00e0 m\u1ed9t ch\u1ec9 d\u1ea5u b\u1ec7nh \u0111\u1ed3ng m\u1eafc quan tr\u1ecdng trong PE c\u1ea5p t\u00ednh.<\/span><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-32180\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-599.png\" alt=\"muc-do-nang-thuyen-tac-phoi\" width=\"684\" height=\"762\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-599.png 684w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-599-269x300.png 269w\" sizes=\"(max-width: 684px) 100vw, 684px\" \/><\/p>\n<h3><strong>1.6. Chi\u1ebfn l\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0Vi\u1ec7c ph\u00e2n \u0111\u1ed9 n\u1eb7ng PE v\u00e0 nguy c\u01a1 t\u1eed vong s\u1edbm (l\u00fac n\u1eb1m vi\u1ec7n ho\u1eb7c 30 ng\u00e0y) \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 8. \u0110\u00e1nh gi\u00e1 nguy c\u01a1 trong PE c\u1ea5p \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u khi nghi ng\u1edd v\u1ec1 b\u1ec7nh v\u00e0 b\u1eaft \u0111\u1ea7u qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n. \u1ede giai \u0111o\u1ea1n s\u1edbm n\u00e0y, vi\u1ec7c x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n (nghi ng\u1edd m\u1eafc) PE nguy c\u01a1 cao l\u00e0 r\u1ea5t quan tr\u1ecdng. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">T\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng n\u00e0y c\u1ea7n m\u1ed9t l\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n c\u1ea5p c\u1ee9u (H\u00ecnh 4) v\u00e0 h\u1ed9i ch\u1ea9n ngay l\u1eadp t\u1ee9c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u. X\u00e9t nghi\u1ec7m d\u1ea5u \u1ea5n sinh h\u1ecdc nh\u01b0 troponins tim ho\u1eb7c natriuretic peptide l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft cho quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc PE nguy c\u01a1 cao.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-32181\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-600.png\" alt=\"chan-doan-thuyen-tac-phoi-nguy-co-cao\" width=\"599\" height=\"714\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-600.png 599w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-600-252x300.png 252w\" sizes=\"(max-width: 599px) 100vw, 599px\" \/><\/p>\n<p><span style=\"font-weight: 400;\">N\u1ebfu kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng khi nh\u1eadp vi\u1ec7n, khuy\u1ebfn c\u00e1o l\u00e0 ti\u1ebfp t\u1ee5c ph\u00e2n t\u1ea7ng nguy c\u01a1 PE, v\u00ec n\u00f3 c\u00f3 \u00fd ngh\u0129a \u0111\u1ed1i v\u1edbi xu\u1ea5t vi\u1ec7n s\u1edbm so v\u1edbi nh\u1eadp vi\u1ec7n ho\u1eb7c theo d\u00f5i b\u1ec7nh nh\u00e2n (gi\u1ea3i th\u00edch trong ph\u1ea7n 7). B\u1ea3ng 8 cung c\u1ea5p t\u1ed5ng quan v\u1ec1 l\u00e2m s\u00e0ng, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t PE nguy c\u01a1 trung b\u00ecnh v\u00e0 nguy c\u01a1 th\u1ea5p. PESI \u2013 b\u1ea3n g\u1ed1c ho\u1eb7c b\u1ea3n \u0111\u01a1n gi\u1ea3n h\u00f3a \u2013 l\u00e0 thang \u0111i\u1ec3m l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn v\u00e0 s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t cho \u0111\u1ebfn nay, v\u00ec n\u00f3 t\u00edch h\u1ee3p c\u00e1c ch\u1ec9 s\u1ed1 c\u01a1 b\u1ea3n v\u1ec1 \u0111\u1ed9 n\u1eb7ng c\u1ee7a PE c\u1ea5p t\u00ednh v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m n\u1eb7ng v\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc c\u1ee7a b\u1ec7nh nh\u00e2n. Nh\u00ecn chung, PESI \u0111\u1ed9 I-II ho\u1eb7c sPESI b\u1eb1ng 0 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o \u0111\u00e1ng tin c\u1eady cho PE nguy c\u01a1 th\u1ea5p.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ngo\u00e0i c\u00e1c th\u00f4ng s\u1ed1 l\u00e2m s\u00e0ng, nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 trung b\u00ecnh c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV (tr\u00ean si\u00eau \u00e2m tim ho\u1eb7c CTPA) k\u00e8m theo n\u1ed3ng \u0111\u1ed9 d\u1ea5u \u1ea5n sinh h\u1ecdc tim t\u0103ng cao trong tu\u1ea7n ho\u00e0n (\u0111\u1eb7c bi\u1ec7t l\u00e0 x\u00e9t nghi\u1ec7m troponin tim d\u01b0\u01a1ng t\u00ednh) s\u1ebd \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh nh\u00f3m c\u00f3 nguy c\u01a1 trung b\u00ecnh-cao. Nh\u01b0 s\u1ebd \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn chi ti\u1ebft h\u01a1n trong ph\u1ea7n 7, nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm m\u1ea5t b\u00f9 huy\u1ebft \u0111\u1ed9ng ho\u1eb7c suy s\u1ee5p tu\u1ea7n ho\u00e0n, v\u00e0 nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u c\u1ee9u m\u1ea1ng. B\u1ec7nh nh\u00e2n RV b\u00ecnh th\u01b0\u1eddng tr\u00ean si\u00eau \u00e2m tim ho\u1eb7c CTPA, v\u00e0\/ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi c\u00f3 m\u1ee9c d\u1ea5u \u1ea5n sinh h\u1ecdc tim b\u00ecnh th\u01b0\u1eddng, thu\u1ed9c v\u1ec1 nguy c\u01a1 trung b\u00ecnh-th\u1ea5p. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Nh\u01b0 m\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn thay th\u1ebf, s\u1eed d\u1ee5ng thang \u0111i\u1ec3m ti\u00ean l\u01b0\u1ee3ng k\u1ebft h\u1ee3p l\u00e2m s\u00e0ng, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u00e1n \u0111\u1ecbnh l\u01b0\u1ee3ng \u0111\u1ed9 n\u1eb7ng PE, v\u00e0 ph\u00e2n bi\u1ec7t PE nguy c\u01a1 trung b\u00ecnh-cao v\u00e0 PE nguy c\u01a1 trung b\u00ecnh-th\u1ea5p. M\u1ee5c d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 4 li\u1ec7t k\u00ea c\u00e1c thang \u0111i\u1ec3m \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u th\u01b0\u1eddng xuy\u00ean nh\u1ea5t cho m\u1ee5c \u0111\u00edch n\u00e0y trong c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t (\u0111o\u00e0n h\u1ec7); tuy nhi\u00ean, kh\u00f4ng c\u00f3 thang \u0111i\u1ec3m n\u00e0o \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong RCT cho \u0111\u1ebfn nay.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p g\u1ea7n \u0111\u00e2y bao g\u1ed3m 21 nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 v\u1edbi t\u1ed5ng s\u1ed1 3295 b\u1ec7nh nh\u00e2n v\u1edbi PE \u2018nguy c\u01a1 th\u1ea5p\u2019 d\u1ef1a tr\u00ean PESI \u0111\u1ed9 I-II ho\u1eb7c sPESI l\u00e0 0. Nh\u00ecn chung, 34% (95% CI 30-39%) trong s\u1ed1 \u0111\u00f3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o c\u00f3 d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV tr\u00ean si\u00eau \u00e2m tim ho\u1eb7c CTPA. D\u1eef li\u1ec7u v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong s\u1edbm \u0111\u01b0\u1ee3c cung c\u1ea5p trong b\u1ea3y nghi\u00ean c\u1ee9u (1597 b\u1ec7nh nh\u00e2n) cho k\u1ebft qu\u1ea3 OR l\u00e0 4.19 (95% CI 1.39-12.58) cho t\u1eed vong do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o khi c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV; n\u1ed3ng \u0111\u1ed9 troponin tim t\u0103ng c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">T\u1ef7 l\u1ec7 t\u1eed vong s\u1edbm do m\u1ecdi nguy\u00ean nh\u00e2n (1.8% khi c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV v\u00e0 3.8% khi c\u00f3 t\u0103ng n\u1ed3ng \u0111\u1ed9 troponin) n\u1eb1m trong ph\u1ea1m vi th\u1ea5p h\u01a1n nh\u1eefng b\u00e1o c\u00e1o tr\u01b0\u1edbc \u0111\u00e2y tr\u00ean b\u1ec7nh nh\u00e2n PE nguy c\u01a1 trung b\u00ecnh. Cho \u0111\u1ebfn khi \u00fd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a nh\u1eefng kh\u00e1c bi\u1ec7t n\u00e0y \u0111\u01b0\u1ee3c l\u00e0m r\u00f5, b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV ho\u1eb7c t\u0103ng d\u1ea5u \u1ea5n sinh h\u1ecdc tim, m\u1eb7c d\u00f9 PESI th\u1ea5p ho\u1eb7c sPESI b\u1eb1ng 0, v\u1eabn n\u00ean \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh nguy c\u01a1 trung b\u00ecnh-th\u1ea5p.\u00a0<\/span><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-32182\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-601.png\" alt=\"phan-do-nang-thuyen-tac-phoi-va-nguy-co-tu-vong-som\" width=\"540\" height=\"781\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-601.png 540w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-601-207x300.png 207w\" sizes=\"(max-width: 540px) 100vw, 540px\" \/><\/p>\n<h3><span style=\"font-weight: 400;\"><strong>1.7. Khuy\u1ebfn c\u00e1o v\u1ec1 \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng<\/strong>\u00a0<\/span><\/h3>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-32183\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-602.png\" alt=\"khuyen-cao-danh-gia-tien-luong\" width=\"510\" height=\"369\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-602.png 510w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-602-300x217.png 300w\" sizes=\"(max-width: 510px) 100vw, 510px\" \/><\/p>\n<p>Xem th\u00eam: <a href=\"https:\/\/vinmecdr.com\/thuyen-tac-dong-mach-phoi-trong-thuc-hanh-lam-sang\/\">Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng (vinmecdr.com)<\/a><\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31473594\/\">2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) &#8211; PubMed (nih.gov)<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thuy\u00ean t\u1eafc ph\u1ed5i l\u00e0 b\u1ec7nh c\u1ea7n ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb nhanh ch\u00f3ng nh\u1eb1m h\u1ea1n ch\u1ebf nguy c\u01a1 t\u1eed vong. \u0110\u1ec3 ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n, b\u00ean c\u1ea1nh nh\u1eadn \u0111\u1ecbnh l\u00e2m s\u00e0ng, vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i v\u00e0 nguy c\u01a1 t\u1eed vong c\u0169ng \u0111\u00f3ng vai tr\u00f2 \u0111\u1eb7c [&hellip;]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0110\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i - ESC 2019\u00a0 - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00ean c\u1ea1nh nh\u1eadn \u0111\u1ecbnh l\u00e2m s\u00e0ng, vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i v\u00e0 nguy c\u01a1 t\u1eed vong c\u0169ng \u0111\u00f3ng vai tr\u00f2 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0110\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i - ESC 2019\u00a0 - Vinmec\" \/>\n<meta property=\"og:description\" content=\"B\u00ean c\u1ea1nh nh\u1eadn \u0111\u1ecbnh l\u00e2m s\u00e0ng, vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i v\u00e0 nguy c\u01a1 t\u1eed vong c\u0169ng \u0111\u00f3ng vai tr\u00f2 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/danh-gia-do-nang-thuyen-tac-phoi-esc-2019\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-07T06:27:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-16T18:41:26+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/F0271974-Pulmonary_embolism_illustration.jpg\" \/>\n<meta name=\"author\" content=\"An Huynh Phan Ngoc\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"An Huynh Phan Ngoc\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"17 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/danh-gia-do-nang-thuyen-tac-phoi-esc-2019\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/danh-gia-do-nang-thuyen-tac-phoi-esc-2019\/\",\"name\":\"\u0110\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i - ESC 2019\u00a0 - Vinmec\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-05-07T06:27:00+00:00\",\"dateModified\":\"2023-05-16T18:41:26+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/106da77d14bd9697d17d477cee4fe3b8\"},\"description\":\"B\u00ean c\u1ea1nh nh\u1eadn \u0111\u1ecbnh l\u00e2m s\u00e0ng, vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i v\u00e0 nguy c\u01a1 t\u1eed vong c\u0169ng \u0111\u00f3ng vai tr\u00f2 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/danh-gia-do-nang-thuyen-tac-phoi-esc-2019\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/danh-gia-do-nang-thuyen-tac-phoi-esc-2019\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/danh-gia-do-nang-thuyen-tac-phoi-esc-2019\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"\u0110\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng thuy\u00ean t\u1eafc ph\u1ed5i &#8211; 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